NAME TRANSFER FORMS

FORM-1 ( Refer to Regulation 5(7))

To
The Designated Engineer,
……………………………,
………….

I, Thiru ........................................ (S/o)/ (D/o)/ (W/o) .................................. aged … Years, am

residing at (Full Address & Phone No.)………………………………………………………………------
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The premises bearing Door No ............... Name of Street......................................Village / Town
…………………………………. Taluk with Service Connection No....... Tariff
……………………………….. Distribution ………………………………………. In the name of
………………………………………….. s/o…………………………………………………………… is
in my possession.

1) The Xerox copy of the sale deed in my favour for the said premises is enclosed.
or
The property tax receipt for the above property is given in my name and Xerox copy of the same
duly attested by Gazetted Officer is enclosed.
or
Metro Water / Sewerage Connection is given in my name and the Xerox copy of the same duly
attested by Gazetted Officer is enclosed.
or
Legal Heirship Certificate from the Tahsildar concerned

2) Application and Agreement Form

3) Indemnity Bond on Rs.80/- Non-judicial stamp paper ( Applicable in the case of name transfer
due to legal succession)

I undertake to pay amounts outstanding against the Account No……… which are found to be due
at a later date.

I request that the name of Service No.. …………………… may kindly be changed to my name.

Signature of transferee,

Full Address.

Place

Date